Naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms

1999 ◽  
Vol 19 (5) ◽  
pp. 37-47
Author(s):  
LA Iacono
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Critical Care ◽  
Postoperative Care ◽  
Regional Blood Flow ◽  
Neurological Complications ◽  
Critical Care Nurses ◽  
Treatment Modalities ◽  
Assessment Skills ◽  
New Treatment

The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. Critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. Critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.

Regional blood flow in the brain and spinal cord of hypothermic rats

1989 ◽  
Vol 257 (3) ◽  
pp. H785-H790
Author(s):  
T. Sakamoto ◽  
W. W. Monafo
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Brain Stem ◽  
Regional Blood Flow ◽  
Experimental Conditions ◽  
Pentobarbital Sodium ◽  
Arterial Blood ◽  
Group A ◽  
Group B ◽  
The Brain

[14C]butanol tissue uptake was used to measure simultaneously regional blood flow in three regions of the brain (cerebral and cerebellar hemispheres and brain stem) and in five levels of the spinal cord in 10 normothermic rats (group A) and in 10 rats in which rectal temperature had been lowered to 27.7 +/- 0.3 degrees C by applying ice to the torso (group B). Pentobarbital sodium anesthesia was used. Mean arterial blood pressure varied minimally between groups as did arterial pH, PO2, and PCO2. In group A, regional spinal cord blood flow (rSCBF) varied from 49.7 +/- 1.6 to 62.6 +/- 2.1 ml.min-1.100 g-1; in brain, regional blood flow (rBBF) averaged 74.4 +/- 2.3 ml.min-1.100 g-1 in the whole brain and was highest in the brain stem. rSCBF in group B was elevated in all levels of the cord by 21-34% (P less than 0.05). rBBF, however, was lowered by 21% in the cerebral hemispheres (P less than 0.001) and by 14% in the brain as a whole (P less than 0.05). The changes in calculated vascular resistance tended to be inversely related to blood flow in all tissues. We conclude that rBBF is depressed in acutely hypothermic pentobarbital sodium-anesthetized rats, as has been noted before, but that rSCBF rises under these experimental conditions. The elevation of rSCBF in hypothermic rats confirms our previous observations.

Regional blood flow in transected rat spinal cord during hypothermia

1990 ◽  
Vol 259 (6) ◽  
pp. H1649-H1654
Author(s):  
T. Sakamoto ◽  
A. Iwai ◽  
W. W. Monafo
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Sciatic Nerve ◽  
Rectal Temperature ◽  
Regional Blood Flow ◽  
Spinal Cord Transection ◽  
The Other ◽  
Rat Spinal Cord ◽  
Caudal Spinal Cord

Regional blood flow (RBF) increases in the spinal cord and sciatic nerve of acutely hypothermic rats. To determine whether cord transection affects this response, we measured RBF in rat spinal cord and sciatic nerve 2 h after cord transection at vertebrae T8 (n = 18 rats) and T11 (n = 18 rats) using [14C]butanol distribution. Nine in each group were normothermic controls. In T11 transection-hypothermia (25-27 degrees C rectal temperature), RBF increased in the three rostral cord segments by 28-40% (P less than 0.05); caudally, cord RBF was depressed in two segments (P less than 0.05), unchanged in the other; RBF fell in nerve (P less than 0.05). In T8 transection-hypothermia, RBF was unchanged in the two rostral cord segments; caudally, RBF was depressed in one cord segment (P less than 0.05) and unchanged in the others; RBF was unchanged in nerve. We conclude that RBF does not rise in caudal spinal cord segments or in sciatic nerve during hypothermia in rats with prior spinal cord transection.

Assessment of regional blood flow in cerebral motor and sensory areas in patients with spinal cord injury

2006 ◽  
Vol 1109 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Tevfik Fikret Çermik ◽  
Hakan Tuna ◽  
Meryem Kaya ◽  
Filiz Tuna ◽  
Aziz Gültekin ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Blood Flow ◽  
Regional Blood Flow ◽  
Cord Injury

Guanethidine chemical sympathectomy: spinal cord and sciatic nerve blood flow

1993 ◽  
Vol 265 (4) ◽  
pp. H1155-H1159
Author(s):  
Y. Kinoshita ◽  
W. W. Monafo
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Sciatic Nerve ◽  
Regional Blood Flow ◽  
Nerve Fibers ◽  
Chemical Sympathectomy ◽  
Nerve Blood Flow ◽  
Biceps Femoris Muscle ◽  
Group I ◽  
Group Ii

The spinal cord vasculature is innervated by noradrenergic nerve fibers, the role of which in the regulation of regional spinal cord blood flow (RSCBF) is presently unclear. We used the distribution of [14C]butanol to simultaneously measure RSCBF at seven cord levels and the regional blood flow in sciatic nerve (NBF), truncal skin, and biceps femoris muscle. The subjects were control rats and rats that had been given parenteral guanethidine sulfate for 5 wk to induce selective postganglionic "chemical sympathectomy." Flows were measured under basal conditions (group I) and immediately after an arterial hemorrhage (group II). The results indicate that RSCBF was unchanged from control after guanethidine administration in both groups; however, NBF was elevated after guanethidine by 47% in group I and by 41% in group II. We conclude that in the spinal cord as in the brain, sympathetic inflow does not appear to have an important role in the regulation of regional blood flow. Sympathetic inflow appears to partly regulate NBF, however, probably by varying vascular tone.

Managing Cancer-Related Pain in Critical Care Settings

2011 ◽  
Vol 22 (4) ◽  
pp. 365-378
Author(s):  
Elisabeth A. Dolan ◽  
Judith A. Paice ◽  
Sally Wile
Keyword(s):  
Critical Care ◽  
Spiritual Care ◽  
Critical Care Nurses ◽  
Treatment Modalities ◽  
Common Symptom ◽  
Challenging Problem ◽  
Team Members ◽  
Care Intervention ◽  
Advanced Stages ◽  
Selection Of

Pain is a common symptom experienced by individuals who are in treatment for cancer and becomes more prevalent for those with more advanced stages of malignancy. Critical care nurses are essential in the management of cancer-related pain, which is a challenging problem when individuals who have a cancer diagnosis are admitted to the intensive care unit for emergent conditions. Regular, thorough, and patient-appropriate assessments by experienced critical care nurses guide selection of treatment modalities, including pharmacologic and nonpharmacologic techniques. In addition, existential pain necessitates spiritual care intervention, and involvement of other appropriate interdisciplinary team members can result in improved management of all types of pain experienced by critically ill individuals with cancer.

Effect of acute spinal cord compression injury on regional spinal cord blood flow in primates

1976 ◽  
Vol 45 (6) ◽  
pp. 660-676 ◽  
Author(s):  
Alan N. Sandler ◽  
Charles H. Tator
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
White Matter ◽  
Cord Blood ◽  
Gray Matter ◽  
Regional Blood Flow ◽  
Compression Injury ◽  
Spinal Cord Blood Flow ◽  
Content Type ◽  
Cord Injury

✓ Spinal cord blood flow (SCBF) was measured in 24 rhesus monkeys after injury to the cord produced by the inflatable circumferential extradural cuff technique. Measurement of regional blood flow in the white and gray matter of the cord in areas of 0.1 sq mm was achieved with the 14C-antipyrine autoradiographic technique and a scanning microscope photometer. After moderate cord injury (400 mm Hg pressure in the cuff maintained for 5 minutes), which produced paraplegia in 50% of animals and moderate to severe paresis in the other 50%, mean white matter SCBF was significantly decreased for up to 1 hour. White matter blood flow then rose to normal levels by 6 hours posttrauma and was significantly increased by 24 hours posttrauma. Gray matter SCBF was significantly decreased for the entire 24-hour period post-trauma. After severe cord injury (150 mm Hg pressure in the cuff maintained for 3 hours), which produced total paraplegia in almost all animals, SCBF in white and gray matter was reduced to extremely low levels for 24 hours posttrauma. In addition, focal decreases in SCBF were seen in white and gray matter for considerable distances proximal and distal to the injury site. It is concluded that acute compression injury of the spinal cord is associated with long-lasting ischemia in the cord that increases in severity with the degree of injury.

scholarly journals Effect of cervical spinal cord stimulation on regional blood flow and oxygenation in advanced head and neck tumours

2004 ◽  
Vol 15 (5) ◽  
pp. 802-807 ◽  
Author(s):  
B. Clavo ◽  
F. Robaina ◽  
L. Catalá ◽  
J.L. Pérez ◽  
M. Lloret ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Head And Neck ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Regional Blood Flow ◽  
Advanced Head ◽  
Head And Neck Tumours

Understanding the oxyhemoglobin dissociation curve

1995 ◽  
Vol 15 (5) ◽  
pp. 54-58 ◽  
Author(s):  
SL Dickson
Keyword(s):  
Critical Care ◽  
Oxygen Affinity ◽  
Critical Care Nurses ◽  
Treatment Modalities ◽  
Dissociation Curve ◽  
Patient Assessment ◽  
Oxyhemoglobin Dissociation Curve ◽  
Hemoglobin Oxygen Affinity ◽  
Oxygenation Status ◽  
Oxyhemoglobin Dissociation

The oxyhemoglobin dissociation curve helps critical care nurses to better understand how various factors affect the oxygenation status of patients. Disease processes or treatment modalities that may cause shifts in the curve should be identified and the effects of the increased or decreased affinity assessed. Knowledge of conditions that affect hemoglobin-oxygen affinity, results of careful patient assessment, and oxygenation monitor readings allow critical care nurses to intervene and attempt to correct tissue hypoxia of critically ill patients.

Sign in / Sign up

Export Citation Format

Share Document